Micromedex® 2.0 - Basic training for pharmacists

Micromedex Clinical Knowledge Suite - Basic Training for Pharmacists Hi, my name is Carolyn Smith. I'm a Clinical Client Relations Manager at Truven Health Analytics. Today I'm going to give you a brief demo on the Micromedex Clinical Knowledge Suite delivered on the Micromedex 2.0 platform. If you're not familiar with Truven Health or Micromedex solutions, we specialize in evidence-based professional disease and drug information for nurses, pharmacists, and physicians in corresponding patient education materials. We will begin by clicking on the Micromedex 2.0 button. From the gateway page, clicking on the Micromedex 2.0 button will take you directly to the home page. What's nice is that you'll never actually have to come back to this home page because the search bar will stay with you everywhere you go. One important thing to highlight on the home page is the Micromedex NewsFeed. The NewsFeed is a convenient way to stay informed of late breaking clinical news. Micromedex solutions product and event information, as well as find tips to help you utilize our tools to support better patient care. Any search you perform searches the Micromedex Clinical Knowledge database, a single source solution for drug, disease, and toxicology information. You can simply start typing the first few letters of what you're looking for and if the topic or keyword you're looking for appears, select if and click Search. If not, continue typing your search term. As a Micromedex 2.0 user, you can access the other products in your Clinical Knowledge Suite, such as Micromedex NeoFax or Micromedex CareNotes in the tool section displayed across the top of the page. When you click on a term and hit Search, in this case were looking for a drug, it will take us immediately into the drug dashboard, which is your access point to a wide variety of information. Note that for medications that have more than one salt or base form, you can access information specific for the one you were interested in, and you can roll over the available routes button to display the route of administration right below the drug name to help find the one you need quickly. The links and the first section take you to the summary level information. Information accessed here will be concise, actionable, at the point of care, and designed to get you an answer very quickly for routine questions. If you know that what you're looking for is more complex and requires more detail, you can click on the View detailed document link and you will be taken immediately into the detailed monograph. Also from the dashboard, you can complete side by side drug comparisons, and tox(icology) and drug product lookups or search for product availability, packaging, and pricing, and the Micromedex formulary REDBOOK online. To the right, you can view images and descriptions for many different products of various strength and manufacturers. Beneath drug images are links to drug consults, which are evidence-based, fully referenced documents that cover a wide range of topics. We have over five hundred consults covering comparative dosage tables, discussions of drug class effects, overview of drug treatment guidelines, and other information not fitting nicely into individual drug monographs. They can be an additional valuable reference source for clinicians. The drug dashboard includes drug consults related to the drug that you searched for. For instance, here is a review of the metabolic backs report with anti-psychotic agents which is applicable to Olanzapine. Beneath that are the links to comparative efficacy content, which provides evidence comparing drugs for a given indication or related to the occurence of a particular adverse effect. This could be helpful in identifying alternative therapies. Moving on towards the middle of the page you will find the links to additional related information. The information is organized using accordion menus so if you would like to view the information go ahead and give these are click. And of course you can dive deeper. If not, simply click again to collapse. No needless scrolling. Towards the bottom of the page are all of your search results. These are ranked by order of relevance very much like internet search engines do with their search results. Back at the top, I'd like to show you what the summary level information looks like. In particular, note that summary adverse effects are restricted to common and the most serious to alert you to the most important adverse effects to be aware of at the point of care. You can easily access more details to conduct a more thorough assessment when needed by selecting View detailed information and Micromedex standard drug information. Accessing adult dosing from the dashboard is another example of that concise and actionable information. It's also important to point out that we provide both FDA-approved dosing as well as off-label dosing when the evidence is clear. For instance, dosing for Olanzapine in chemotherapy-induced nausea and vomiting is supported by good quality clinical trials so you will find it we have provided this off label information. You may notice that our content is fully referenced and complete citations may be viewed by selecting the Citation hyperlink. While we're still in the dosing and indication section, I would like to point out the non FDA-labeled indication section. We have more off-label content than any other clinical resource. Clicking on the info button next to the indication allows you to view the ratings associated with each indication. Ratings for efficacy, strength of recommendation, and strength of evidence are developed by our in-house clinical editorial team, applying unparalleled content development standards. These ratings are available for all indications both FDA-approved and off-label and provide guidance to clinicians to quickly identify potential therapeutic options and alert you to situations in which a drug should not be used. Remember that the summary information is intended for concise and routine information needs but you can always access additional details for your more complex cases. We provide the details you need to determine if the recommendations are applicable to your specific patient. I want to dive a little deeper here and click on the View detailed information tab to move us into Micromedex standard drug information, where you'll find quite a bit more information so still in the same section for non FDA-labeled indications but far more content. While we are in the detailed document, I'd like to point out the Storage and Stability section. Here you can find details related to drug preparation in administration, which are especially important when special precautions are required. Let's try another drug search for Doxycycline and again we are taken to the drug dashboard. From here we can also access some useful tools. Clicking on drug interactions (single) brings up a list of interactions associated with the drug. We cover not only drug drug interactions, but also food, tobacco, alcohol, lab interactions, and pregnancy and lactation concerns. Interactions are grouped by type and ordered by severity, from contraindicated down to minor. For each interaction you will see a brief summary on the right hand side. To access more details, clicking on the interaction itself will display much more information such as clinical management recommendations to guide patient care in addition to literature reports and references. From here you can also access our interactive drug interaction tool by selecting view multiple drug interactions at the top of the list. You'll notice our drug is automatically carried over and now you can enter up to twenty other drugs including alternative medications. So maybe a patient is considering taking Saint John's wort as a supplement for melatonin. Ginkgo, cardamom, or any of those can be included here. Allergies can also be accounted for in the list. If the patient has a penicillin, peanut, or even a red dye allergy, click Update to add it to our list. Once your list is complete, choose Submit and the system will screen for interactions between the agents on the list you just built. Back to our Dashboard: another tool you can access from here is IV compatibility screening. Our IV compatibility information comes from Trissel's 2 clinical pharmaceutical database, the most complete and current resource for compatibility information. By selecting IV compatibility (single), you access comprehensive compatibility data for Doxycycline Hyclate. You initially land in the solution compatibility results. The seven most common solutions will be listed first, followed by another important solution directly below. In addition you also get the compatibility results for Y-site, Admixture, Syringe, TPN TNA solutions so if you click on Y-site, for example you bring up Y-site compatibility information for all the medications with Doxycycline Hyclate. You'll notice that the results are icon- driven for quick identification of compatible, incompatible, and various results. The detailed information needed to make a safe clinical decision, such as drug concentrations fluids, and storage conditions are available by selecting a specific drug combination. Back to the top: As with the drug interaction example, you can go from single IV compatibilities right into building a list screen by clicking on this tab. Doxycycline is automatically carried over once again and now you can enter up to twenty IV drugs. Once you are ready to go, submit in the system screens for compatibility issues for the list that we just filled. and the information is available for the Y-Site, the admixture, and for the syringe. Within the tool you'll notice that you can now access Trissels IV drug monographs from the icon next to the drug name and All Drugs box on the left. These are detailed monographs you are used to seeing in the Trissels printed handbook so now you can access important information such as maximum stability, effects of lighter freezing and filtration requirements right within our tool. Back to our dashboard: Another thing I'd like to point out that you can do from here is side by side comparison. Clicking on this automatically populates the drug for us so this drug comparison tool allows you to enter in a list of up to twenty drugs and compare them side by side, two at a time. Submit your drug list to access side by side comparisons of our summary drug content, section by section, which makes for a very quick and easy comparative read. If you want to look at just the adverse effects, clicking on the adverse effects in the Jump To section will move you right into that portion of the document where you can clearly see both the common and the serious adverse effects, compared side by side. So from the dashboard we're now able to screen drug interactions and IV compatibilities as well as compare two drugs side by side, in addition to accessing general drug information. It is really designed to enhance your workflow and put all the drug information you need right at your fingertips. In addition to accessing all of your drug interactions, IV compatibility, and drug comparison tools from the dashboard you may also open them directly from the toolbar across the top There are several other useful tools to point out here as well. Drug Identification allows you to search for a tablet or capsule, by imprint code if you have it, or just a description. Go ahead and type in whatever imprint code you have and hit Search. Anything that matches the code you typed in will be pulled up. When you select the drug name to access additional product descriptors and exipient information You'll also notice on the right hand side you can directly access toxicology management documents to help manage overdose in accidental exposure situations. If I want to view any available pictures I can select search images. Now I can verify this is what i have if you don't have an imprint code you can always search based on a description select a modified identification to get back to the initial entry screen and then click No Imprint Code. click here to search by description. If you have a black and gold capsule for example anything that matches that criteria will be pulled up for you. Again, just select the drug name to access additional details to verify your identification. Back up to the Tools across the top: Tox & Drug product lookup allows you to search a database of hundreds of thousands of drugs, chemical and household products. From here you can access product ingredients and manufacturers contact information and drug product excipients. Search results also include links to our toxicology management documents which are used in every U.S. Poison control center. Just as you have seen you can access drug and toxicology content in the Clinical Knowledge Suite. You can also find disease information, making us a single source for all your clinical information needs. As with the drug search, a disease or condition search initially takes you to a dashboard. The links from the dashboard take you to concise, actionable information and our summary documents, but you can also access detailed monographs for your more complex information needs. On this dashboard, also notice clinical checklist which are our evidence-based lists of what you should always or never do when managing patients with a given condition. Applicable performance answers are denoted as well on the right. Back to the dashboard: for diabetes mellitus: If you scroll down the page you will see that you can view search results and other content sets, such as drug information, drug consults, and alternative medicine. Earlier I mentioned that you can access drug pricing and availability information by running a search in the RED BOOK online directly from the drug dashboard. You can also access the RED BOOK directly from the top tools section. Back up towards the top, one more tool to point out is our Calculators. Everything from measurement calculators including BMI lean ideal body weight, and surface area, and metric conversions Two drug testing tools and the ACLS and PALS guidelines calculator in the middle of the page. The ACLS and PALS tool allows for the calculation of a weight-based, emergency dosing information for adult and pediatric patients. You get the drug route, dose, and delivery instructions. You can also print either the patient's name here, print it and keep it in the patient's chart or at the bedside. Now that you have a feel for how to navigate around the dashboards, I'd like to share a few ways that Micromedex 2.0 incorporates more robust searching to help you get to specific information more quickly. We have implemented phrased or targeted searching that brings back very specific results. For instance, if you need to review a patient's lengthy list of medications to see if any of them could be responsible for a new adverse affect that has developed just search 'drugs that cause' any condition to bring back a list of medications with this as an adverse effect. You can compare your patient's medications to this list, then go directly into the adverse affects section for the medication of interest to review important information. If the drug of choice for a given indication is on backorder, you can search drugs that treat any condition to access to a list of medications categorized by efficacy rating with relevant populations noted to help identify alternatives From the list you can directly access dosing and indication content. How do you keep up with new and safety information to minimize risk associated with medication use? From Micromedex 2.0 you can now identify all drugs that have black box warnings or REMS requirements by searching, using those terms and then access safety details. In addition to those specialized searches, you may also conduct a full-text search from the main search box. For instance, by searching 'Narcotic' you will bring back a wide variety of results from many different content areas, the first being a very helpful drug consult, narcotic analgesic comparative review, which provides at well, analgesic, dosing, and duration of action of narcotic analgesics to assist conversions from one agent to another. To access a list of over five hundred evidence-based drug consults, just search 'Drug Consults' in the main search box. You can also search using multiple terms such as searching Digoxin, or treatment of diabetes or morphine adverse reactions to access these specific areas more quickly. To see some examples of searches you can refer to the example search button next to the search bar. Last but not least I'd like to point out the mobile Micromedex link in the upper left hand corner. For iphone, iPad, and Android users we have three drug apps that you can download by searching in the Apple app store or Google play for Micromedex. The first app is all summary information for drugs approved and marketed in the U.S. and allows you to search by drug name or by class. The other apps mimic the drug interaction and IV Compatibility tools I showed you. Be sure to follow these instructions in order to gain free access through your subscription at the hospital. If you have a personal mobile device such as an Apple iPhone or an iPad or an Android OS Smart phone or tablet, you can also access Micromedex 2.0 from these devices from anywhere for free because your hospital has a subscription. Click on the device you have and follow the instructions. Also the Contact Us link is at the bottom of the page if you have a question about our products please click on the contact us link, then fill out the text box. Once you hit Submit it'll go straight to our customer resource center and they'll get back to you with the help you need. If you want additional training, always remember there is a training link at the bottom every Micromedex 2.0 page. There you can access Micromedex 2.0 tutorials, register for online recorded sessions or live sessions and you can also access all the information that you need for additional resources. This concludes our training session for Micromedex Clinical Knowledge basic training for pharmacists. For more information, contact us at truvenhealth.com contact us at truvenhealth.com